Escolar Documentos
Profissional Documentos
Cultura Documentos
4. Contract Number
7. Duration of Assignment
11. Names, Ages and Relationship of Dependents to Accompany Individual to Country of Assignment
MAJOR
14, EMPLOYMENT HISTORY 1. 2. Give last three (3) years. List salaries separate for each year. Continue on separate sheet of paper if required to list all employment related to duties of proposed assignment. Salary definition - basic periodic payment for services rendered. Exclude bonuses, profit-sharing arrangements, commissions, consultant fees, extra or overtime work payments, overseas differential, or quarters, cost of living or dependent education allowances.
EMPLOYERS NAME AND ADDRESS POINT OF CONTACT AND TELEPHONE # Dates of employment (M/D/Y) From To Annual Salary Kenya Shillings
POSITION TITLE
Days at Rate
16. CERTIFICATION: To the best of my knowledge, the above facts as stated are true and correct.
Date:
Contractor certifies in submitting this form that it has taken reasonable steps (in accordance with sound business practices) to verify the information contained in this form. Contractor understands that USAID may rely on the accuracy of such information in negotiating and reimbursing personnel under this contract. The making of certifications that are false, fictitious or fraudulent, or that are based on inadequately verified information may result in appropriate remedial action by USAID, taking into consideration all of the pertinent facts and circumstances, ranging from refund claims to criminal prosecution. Signature of Contractors Representative Date
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INSTRUCTION
Indicate your language proficiency in block 13 using the following numeric Interagency Language Roundtable levels (Foreign Service Institute Levels). Also, the following provides brief descriptions of proficiency levels 2, 3, 4, and 5. S indicates speaking ability and R indicates reading ability. For more in-depth description of the levels refer to USAID Handbook 28 or superseding policy directive. 2. S R Limited working proficiency
3. S
4. S R 5. S
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